TBI accounts for about 1.4 million emergency room visits, 275,000 hospital admissions, and 52,000 deaths each year in the US. The reported prevalence of post-traumatic seizures (PTS) following TBI varies; rates of clinical PTS are around 12%, however, subclinical seizures detected on electroencephalogram may be as high as 20-25%. The development of seizures following TBI can be debilitating to patients, complicates management, and increases associated healthcare costs, leading to the rationale for PTS prophylaxis in severe TBI. Both the 2016 Guidelines for the Management of Severe traumatic Brain Injury and the American Academy of Neurology recommend phenytoin to decrease the incidence of early PTS. Current guidelines state available studies are insufficient to support a recommendation for or against the use of levetiracetam for PTS prophylaxis. Phenytoin usage requires routine monitoring of serum drug levels to maintain levels within a narrow therapeutic window. Phenytoin also has a well-understood side effect profile and the potential for significant drug interactions. In the past decade, several studies have been conducted comparing the effectiveness of phenytoin with levetiracetam for PTS prophylaxis, as an alternative agent that lacks the major disadvantages of phenytoin (more favorable side effect profile and no need for routine drug level monitoring). Previous levetiracetam studies lacked standardized protocols so there is uncertainty regarding the best dosing strategy and utilization of this therapy. A worldwide survey to characterize current clinical practice regarding the utilization of early PTS prophylaxis could be very helpful in standardizing therapy and designing future research.

Target Audience: All NCS members

POCUS/CCU is a non-invasive and low-cost bedside assessment that can provide real-time information in the management of critically-ill patients. Studies have shown that POCUS/CCU can improve diagnostic accuracy in undifferentiated shock, reduce the length of time on mechanical ventilation and the need for conventional diagnostic imaging, and shorten intensive care unit length of stay. The use of POCUS/CCU has been shown to help prevent secondary brain injury due to hemodynamic disruptions that are particularly unique to patients with critical neurological illness. The use of POCUS/CCU in medical and surgical intensive care units has increased tremendously over the last few decades. However, it is unclear if POCUS/CCU use by neurointensivists has similarly translated with the advent of specialized neurocritical care units. Additionally, prior surveys on ultrasound use in critical care units and training have largely queried non-neurointensivists and non-neurocritical care fellowship trainees. The purpose of this survey is to describe the current state of POCUS/CCU use among neurointensivists for management of neurocriticallyill patients in dedicated neurocritical care units throughout the NCS community.

Target Audience: US-based MDs, APs, Trainees (fellows, residents, medical students)